Options after in-stent thrombosis?

[hsc]

Hi,

My father had an angioplasty with stenting 3 months ago.
One of the stent was drug eluting, while the other was a Bare metal stent.

He developed acute angina a week ago and was hospitalized.
The angiography revealed that here was a blockage in the drug eluting stent while
the BMS was fine. According to the cardiologist, there was a 50% thrombosis
in the DES.
He was prescribed tirofiban while in the hospital and doesnt have any angina symptoms
at this moment. The doctor says that its because the blood thinners have probably
dissolved the clot.

My father was on plavix all this time, thus is the diagonosis of stent thrombosis
accurate?

Can this be a restinosis and not a thrombus, How easy is to distinguish
one from the other.

Also how likely is it that the blood thinners caused the lysis of the thrombus.
What are our options at this point.

Thanks

HSC

[hsc]

Thanks Dr. Bogart for taking the time to answer this.

We are facing another issue at this time.
We are having a difficult time controlling his blood pressure. We are observing that it becomes higher during the morning hours when it reached 160. This caused him to develop angina again.

He is taking 5 mg ramipril in the morning with 2.5 in the evening.
In addition his is also taking Lasix which was prescribed for a period of 2 weeks.

Should we continue to take Lasix. Is the dosage of Lasix conflicting with the Ramipril in any way. Please advise.

Thanks

[Douglas Bogart, MD]

It is pretty soon for restenosis and likely the mechanism is thrombus in the drug eluting stent.  The tirofiban can help eliminate the clot.  I think your dad should be on triple antiplatelet therapy with aspirin,plavix and clilostazol.